2015–2016 Verification Form
Asset Disclosure Form
The purpose of this form is to verify information about your/your parents’ assets. Assets include: parents’/student’s cash, savings and
checking, real estate, investments, and business/farm net worth. The law says that before awarding Federal Student Aid, we may ask
you to confirm the information you (and your parents if dependent) reported on your FAFSA. To verify that you provided correct
information, we must compare your FAFSA with the information on this worksheet and with any other required documents. If there
are differences, your FAFSA information may need to be corrected. After reviewing this document, we may ask for additional
information. If you have questions about verification, contact us as soon as possible so that your financial aid will not be delayed.
Student’s Information
_______________________________________________
__________________________
Last Name
MCC Student ID #
First Name
M.I.
__________________________(____)_______________ _
__________________________
Student’s E-mail
Date of Birth
Home Phone Number
Asset Disclosure
Please complete the following questions regarding your/your parents’ assets as of the time you completed the FAFSA.
If your answer to a question is zero or none, put “0” in the answer space. DON’T LEAVE ANY BLANKS!
Parent(s)
Student/Spouse
(Dependent Students Only)
Current Net Worth of Investments:
Current Net Worth of Business and/or
Investment Farm:
Balance of Cash, Savings and Checking
Accounts:
Investments includes real estate (do not include the home you live in), trust funds, UGMA and UTMA accounts, money market funds,
mutual funds, certificates of deposit, stocks, stock options, bonds other securities, Coverdell savings accounts, 529 college savings
plans, the refund value of 529 state prepaid tuition plans, installment and land sale contracts (including mortgages held),
commodities, etc. Investment value includes the market value of these investments as of the day you completed your FAFSA. Net
Worth means current value minus debt.
If your parents own a business or an investment farm, list the value of the business or farm at the time of filing. Include the value of
land, buildings, machinery, equipment, livestock, inventories, etc. For the debt, include only the present mortgage and related debts
for which the business or farm was used as collateral. Do not include the value of a family farm that you (your spouse and/or your
parents) live on and operate. Do not include the value of a small business that you (your spouse and/or your parents) own and control
and that has 100 or fewer full-time or full-time equivalent employees.
Certification and Signatures
I certify that all of the information reported on this worksheet is complete and correct.
Dependent Student: Student and one parent must sign this worksheet.
Independent Student: The student must sign this worksheet.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
sentenced to jail, or both.
_________________________________________________
______________________________________________________________
Student’s Signature
Parent’s Signature (if dependent student)
Date
Submit the completed worksheet to:
Muskegon Community College
Student Welcome Center
Or FAX to:
FAX: (231) 777-0475
Date
Or mail to:
Muskegon Community College
Attn: Financial Aid Office
221 S Quarterline Road
Muskegon, MI 49442
You should make a copy of all documents submitted for your records
REV: 03/15
FAC15AST